sodium-ethylxanthate and Kidney-Failure--Chronic

The clinical manifestations of uremia are only incompletely reversed by chronic hemodialysis. Signs and symptoms can include abnormalities in electrophysiologic indices, clinical mental status, and neuropsychological test performance, as well as decreases in exercise tolerance, sexual potency, and general quality of life. Though retention of uremic toxins is responsible for many of these symptom complexes, some may be caused, or substantially aggravated, by the anemia that almost invariably accompanies chronic renal failure. Treatment with recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) increases hematocrit values and thus reduces the anemia, in turn improving brain and cognitive function, exercise tolerance, sexual potency, and quality of life.

Topics: Anemia; Cognition; Erythropoietin; Exercise; Humans; Kidney Failure, Chronic; Quality of Life; Recombinant Proteins; Renal Dialysis; Sex

Life-extending treatment for end-stage renal disease is now accepted standard procedure when feasible. The spectrum of treatable patients is expanding to include many with serious emotional problems. This expansion places an added burden on staff and patient alike, as the stresses produced often cause significiant dysphoria even in the patient who is well integrated emotionally. Psychiatric morbidity must be expected and managed as well as circumstacnes will allow. As in most other human endeavors, patients who are likely to be successful are the fortunate few who can adapt to difficult and chronic stresses, undergo positive emotional experiences, and have a supportive family, satisfying work, solid identity, and comfortable self-esteem--in short, those with good mental health. The discussion speculates on personality or life-experience variables that might have prognostic usefulness.

Topics: Adaptation, Psychological; Adult; Death; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Mental Disorders; Middle Aged; MMPI; Renal Dialysis; Sex; Stress, Psychological; Transplantation, Homologous

Topics: Adaptation, Psychological; Adolescent; Adult; Age Factors; Child; Defense Mechanisms; Family; Female; Humans; Kidney Failure, Chronic; Male; Psychiatry; Renal Dialysis; Role; Sex

The purpose of this study was to evaluate whether levels of sex hormones and sexual function differ in renal failure patients with and without uremia and the effect of treatment with recombinant human erythropoietin (rhuEPO).. Fifteen males with chronic renal failure who were not receiving hemodialysis and 25 male renal failure patients with uremia who were undergoing hemodialysis were enrolled before and after rhuEPO therapy. Fifteen male volunteers matched for age and weight were also studied. Levels of various blood biochemicals were measured in all patients before and 1 week after rhuEPO treatment. Sexual function was also studied in all patients before and 6 months after rhuEPO treatment.. The control group had significantly higher levels of testosterone (6.21 +/- 1.21 ng/ml) and hematocrit (Hct) (43.2 +/- 2.1%) and significantly lower levels of prolactin (5.27 +/- 1.21 ng/ml), follicular-stimulating hormone (FSH) (7.51 +/- 2.36 mIU/ml) and leutinizing hormone (LH) (4.23 +/- 2.10 mIU/ml) than the two patient groups (p < 0.05 for all comparisons). Patients with renal failure only had significantly lower levels of testosterone and Hct (2.54 +/- 0.53 ng/ml and 21.4 +/- 1.4%, respectively) than those with uremia (3.65 +/- 0.52 ng/ml and 24.3 +/- 2.5%, respectively; p < 0.001 for both comparisons). After rhuEPO therapy, the testosterone and Hct levels of the two patient groups did not reach the level of the control subjects (p < 0.05 for both comparisons). Similarly, the levels of prolactin, FSH and LH were significantly higher in both patient groups than those of control subjects after rhuEPO therapy (p < 0.001 for both comparisons). However, after rhuEPO therapy, significant increases in testosterone and Hct levels were found in both patient groups (p < 0.001 for both comparisons). Sexual function was also markedly improved in the hemodialysis patient group. While 20/25 (80%) male hemodialysis patients reported improved sexual function after rhuEPO treatment, only 3/15 (20%) chronic renal failure patients reported improvement.. In patients with advanced uremia, rhuEPO therapy may result in improved gonadotropic hormone levels and sexual function. Good dialysis quality may contribute to the increase in the incidence of patients with better sexual function.

Topics: Erythropoietin; Gonadal Steroid Hormones; Gonadotropins; Humans; Kidney Failure, Chronic; Male; Middle Aged; Recombinant Proteins; Renal Dialysis; Sex; Uremia

Previous studies have revealed that females are less likely than males to receive a renal transplant, the most successful form of treatment of end-stage renal disease (ESRD). The purpose of this study was to determine whether the barrier is to inclusion on the transplant waiting list or to transplantation after being placed on the transplant waiting list. An existing data set was used that included data from the Michigan Kidney Registry, supplemented with data received from the Organ Procurement Agency of Michigan. White and black patients less than 65 years of age and starting ESRD treatment between January 1, 1984, and December 31, 1989, were included. Cox proportional hazards models were used to determine the effect of gender on (1) time to transplantation among all ESRD patients, (2) time from diagnosis of ESRD to inclusion on the transplant waiting list among all ESRD patients, and (3) time from inclusion on the waiting list to transplantation among those patients on the waiting list. Patients were censored at the time of living-related transplantation or death, and were monitored until December 31, 1989. In all, 5,026 incident ESRD patients were included in the study (44.3% female). Of these, 1,626 patients were included on the waiting list (40.1% female); 823 of these received a transplant (37.7% female). Adjusting for age, race, and diagnosis, females were 25% less likely to receive a cadaveric transplant than males (female to male relative rate ratio [RR], 0.75; P < 0.001). Females with ESRD aged 46 to 55 years and 56 to 65 years were 33% (RR, 0.67; P < 0.001) and 29% (RR, 0.71; P < 0.05) less likely to be included on the transplant waiting list, respectively, than their male counterparts. There was no difference in the rate of wait list inclusion among ESRD patients younger than 46 years. Females with ESRD who were included on the transplant waiting list were 26% (RR, 0.74; P < 0.001) less likely to receive a transplant than males on the waiting list. These results indicate that females are both less likely to be on the transplant waiting list (ages over 45 years) and, once on the list, less likely to receive a transplant (all ages) than males. Further study is necessary to determine the factors contributing to these important barriers to transplantation among females with ESRD.

Topics: Adult; Age Factors; Aged; Black People; Cadaver; Cause of Death; Female; Health Services Accessibility; Humans; Kidney Failure, Chronic; Kidney Transplantation; Living Donors; Male; Michigan; Middle Aged; Odds Ratio; Proportional Hazards Models; Registries; Sex; Sex Factors; Time Factors; Tissue and Organ Procurement; Waiting Lists; White People

Topics: Adult; Age Factors; Attitude to Health; Black People; Fear; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Prejudice; Referral and Consultation; Renal Dialysis; Sex; Sex Factors; Social Class; Waiting Lists; White People

Topics: Adult; Coitus; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Kidney Failure, Chronic; Kidney Transplantation; Luteinizing Hormone; Male; Middle Aged; Penile Erection; Prolactin; Renal Dialysis; Sex; Sexual Behavior; Surveys and Questionnaires; Testosterone

Since it has been reported that correction of anemia in long-term hemodialysis patients by using human recombinant erythropoietin (r-HuEPO) is associated with improve sexual function, we conducted the present study to evaluate the changes in sex hormones as well as sexual function after r-HuEPO administration (1500 to 4500 IU per dialysis) for a year in patients on regular hemodialysis. Thirteen patients receiving regular hemodialysis entered this study. Their median age was 43 years. Along with correction of anemia (the hematocrit increased from 20 to 28%), testosterone (T) increased from 2.4 +/- 0.1 to 2.6 +/- 0.2 ng/ml, follicular stimulating hormone (FSH) increased (29 +/- 5 to 73 +/- 7 mIU/ml), luteinizing hormone increased (69 +/- 14 to 160 +/- 21 IU/ml) and prolactin decreased (all changes are significant at p less than 0.05). However, the improvement of sexual function was not remarkable. Only 25% of the uremic patients treated with r-HuEPO showed amelioration of this function. From the present data, it does not seem likely that therapy with r-HuEPO induces directly amelioration of sexual function through changes in sex hormones.

Topics: Adult; Anemia; Erythropoietin; Follicle Stimulating Hormone; Gonadal Steroid Hormones; Humans; Kidney Failure, Chronic; Luteinizing Hormone; Male; Prolactin; Recombinant Proteins; Renal Dialysis; Sex; Testosterone

Topics: Humans; Kidney Failure, Chronic; Kidney Transplantation; Sex; Social Adjustment; Stress, Psychological

A group of 128 patients in an end-stage renal disease programme in Natal was studied in order to assess the relative success of the different treatment modalities in achieving optimal patient rehabilitation in regard to employability and social, psychological and medical status. Confirmation that successful transplantation achieves the best quality of life was obtained.

Topics: Activities of Daily Living; Adolescent; Adult; Aged; Child; Depression; Employment; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Quality of Life; Renal Dialysis; Sex

Topics: Adult; Allied Health Personnel; Attitude of Health Personnel; Education, Nursing, Continuing; Female; Humans; Kidney Failure, Chronic; Male; Nursing Assessment; Sex

Topics: Female; Humans; Kidney Failure, Chronic; Libido; Male; Patient Education as Topic; Renal Dialysis; Sex

Topics: Humans; Kidney Failure, Chronic; Kidney Transplantation; Neurocognitive Disorders; Renal Dialysis; Sex; Transplantation

Topics: Ambulatory Care; Counseling; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Postoperative Care; Sex

Topics: Female; Humans; Infant, Newborn; Kidney Failure, Chronic; Libido; Male; Menstruation; Menstruation Disturbances; Pregnancy; Renal Dialysis; Sex; Sex Factors; Spermatogenesis; Testis; Uremia

Topics: Female; Humans; Kidney Failure, Chronic; Male; Pituitary Gland; Pregnancy; Renal Dialysis; Sex; Testis; Uremia